The Association Between the Intersection of Immigrant Status and Insurance with Adverse Birth Outcomes Among Mexican Women Residing in the San Joaquin Valley: A Mediation Analysis of Late Initiation or No Prenatal Care

Latinos are the largest growing population and have the highest fertility rates in the US. In response, this study assessed if late initiation of or no prenatal care (PNC) mediated the relationship among adverse birth outcomes and interactions between immigrant and insurance status. This study used cross-sectional data (2002–2004) limited to 109,399 women of Mexican ethnicity who had singleton births in the San Joaquin Valley, California. We conducted hierarchical mediation analyses. US-born Mexican women who used private or public insurance for PNC were more likely to have infants born at low-birth weight and premature compared to Mexican first generation immigrant women. Nonetheless, initiation of late or no PNC positively mediated the relationship between infants born premature to Mexican first generation immigrant women who used public insurance ( ab/se(ab) = 2.123, p = .034). Findings from this study support acculturation theory and the need for multilevel approaches to address PNC among women of Mexican ethnicity.